Same-Day Discharge After Minimally Invasive Sacrocolpopexy Is Feasible, Safe, and Associated With High Patient Satisfaction

Abstract

Objectives This study aimed to compare the incidence of adverse events and postoperative health care resource utilization, as well as to determine satisfaction in patients after a same-day discharge (SDD) protocol compared with routine care (discharge ≥postoperative day 1). Methods This is a prospective cohort study of SDD after minimally invasive sacrocolpopexy. Eligibility criteria included age younger than 80 years, American Society of Anesthesiologists grade I/II, caretaker for ≥24 hours postoperatively, and surgical start before 1 pm. Perioperative data were obtained through the medical record and direct patient inquiry. A satisfaction survey was administered at the postoperative visit. A historical control group was used to compare outcomes. Results Forty-seven women met the eligibility criteria. Mean age was 62 (±9) years. Most were White (95.7%), were overweight (body mass index, 27.7 ± 5.5 kg/m2), and had stage 3 prolapse (63.8%). Same-day discharge was achieved for 37 patients (78.7%). Patient characteristics of the SDD cohort were similar to the routine-care cohort, with the exception of previous hysterectomy (57.5% vs 100.0%, P < 0.001) and the American Society of Anesthesiologists score (2 [1–2] vs 2 [1–3], P = 0.002). There were significantly fewer postoperative telephone calls in the SDD cohort but no other differences in health care resource utilization. Adverse events did not differ between groups. The SDD cohort reported high satisfaction and would recommend SDD to family or friends independent of whether or not SDD was achieved (91.9% vs 80.0%, P = 0.29). Conclusions Nearly 80% of women undergoing minimally invasive sacrocolpopexy on an SDD protocol went home as planned. Compared with routine care, there was no increase in adverse events or postoperative health care resource utilization. Patient satisfaction in the SDD cohort was high. Clinical Trial Registration Same-day discharge after minimally invasive sacrocolpopexy, https://clinicaltrials.gov/ct2/show/NCT03730103?term=same+day+discharge&cntry=US&state=US%3AOH&city=Cleveland&draw=2&rank=1; NCT03730103.

Same‐day discharge across FPMRS surgical cases is safe and feasible: A 10‐year single‐surgeon experience

“…A recent population‐based study by Berger and colleagues of over 13 000 patients in a managed care organization comparing same‐day and next‐day discharge following minimally invasive major prolapse surgery reported low 30‐day readmission (1.5%–2%) and ED visit (9.5%) rates with no differences between discharge groups 7 . A prospective cohort study of SDD after minimally invasive sacrocolpopexy from our institution demonstrated no difference in unscheduled office visits, ED visits or readmissions with SDD compared to historical controls admitted postoperatively 8 . Other retrospective studies have similarly found no differences in unplanned postoperative encounters with SDD following vaginal prolapse repair and RASC 4,5 .…”

“…7 A prospective cohort study of SDD after minimally invasive sacrocolpopexy from our institution demonstrated no difference in unscheduled office visits, ED visits or readmissions with SDD compared to historical controls admitted postoperatively. 8 Other retrospective studies have similarly found no differences in unplanned postoperative encounters with SDD following vaginal prolapse repair and RASC. 4,5 In contrast, a study of implementation of an ERAS protocol involving SDD for major prolapse repair found higher rates of 30-day readmission with SDD (1.5% vs. 6.7%, p = 0.03).…”

“…A 2019 survey of patient perceptions of SDD for pelvic organ prolapse indicated 86% would feel comfortable at baseline with SDD, whereas 96% felt comfortable when their surgeon recommended it 12 . Furthermore, our institution's recent prospective assessment of SDD in minimally invasive sacrocolpopexy found 92% satisfaction in the SDD group, with no statistical difference from the 80% satisfaction in the next‐day discharge group 8 …”

“…12 Furthermore, our institution's recent prospective assessment of SDD in minimally invasive sacrocolpopexy found 92% satisfaction in the SDD group, with no statistical difference from the 80% satisfaction in the next-day discharge group. 8 Although our experience represents a wide breadth of FPMRS cases, there are two underrepresented categories. First, we excluded transvaginal prolapse repair with hysterectomy because we deferred postoperative admission decisions to our urogynecology colleagues who performed the hysterectomy.…”

Patient Perspectives toward Undergoing Same-Day Discharge for Apical Pelvic Organ Prolapse Repair Surgery during the COVID-19 Pandemic

“…In the absence of a pandemic, literature supports the safety and feasibility of SDD following minimally invasive FPMRS procedures to improve patient satisfaction without increasing postoperative complications or health care utilization. 5–7,13–17 A recent study of 61 vaginal POP and urinary incontinence surgeries assessing satisfaction and morbidity showed that SDD was well tolerated with high satisfaction and minimal complications. 13 Another study of 272 patients undergoing robotic-assisted sacrocolpopexy with 80 of 272 (29.4%) SDD patients demonstrated no differences in unplanned provider visits, emergency department visits or readmission between both cohorts.…”